Utilization review nurse Jobs in Pearland tx

Imagine360 is seeking an Assistant Appeals Review Specialist! This position compiles and maintains claims and appeal data and supports the Appeals Review Team in an administrative capacity to allow expedited processing. This individual works closely with department members, providers and third-parties to proactively assist in researching concerns and resolving issues to the satisfaction of the client and in accordance with plan provisions. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility.

Position Location : 100% remote

Responsibilities include but are not limited to :

• Appeals Support

Supports organizational processes that are critical to the workflow of the Appeals Review Team.

Contacts medical providers for information needed to complete appeals processing.

Sorts and distributes daily workload, including appeals to be worked, email, mail and other duties.

Acts as a role model in demonstrating the core values in customer service delivery.

Sends letters to providers and members explaining a denial.

Serves on committees, work groups, and / or process improvement teams, as assigned, to assist in improving quality / customer satisfaction.

Required Experience / Education :

Skills and Abilities :

What can Imagine360 offer you?

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.